The present application relates to systems and methods for performing a repair of soft tissue to bone, particularly a partial thickness rotator cuff tear.
A common injury, especially among athletes, is the complete or partial detachment of tendons, ligaments or other soft tissues from bone. Tissue detachment may occur during a fall, by overexertion, or for a variety of other reasons. Surgical intervention is often needed, particularly when tissue is mostly or completely detached from its associated bone. Currently available devices for tissue attachment include screws, staples, suture anchors and tacks.
Arthroscopic tissue attachment is commonly practiced in shoulder rotator cuff and instability procedures utilizing at least one cannula. Typically, an anchor loaded with suture is fixated to bone using an inserter-type device. The suture is normally slidably attached to the anchor through an eyelet or around a post, such that a single length of suture has two free limbs. The suture limbs typically are carried along the exterior of the inserter, usually within a groove or other exterior channel, or within the interior of the inserter. After the anchor is inserted into the bone, one limb of the suture is passed through soft tissue to be repaired such as a tendon or labrum. The two ends of the suture are then tied to each other, thereby capturing the soft tissue in a loop with the anchor. Upon tightening the loop, the soft tissue is approximated to the bone via the anchor.
A PASTA (Partial Articular Surface Tendon Avulsion, also known as Partial Articular Sided Tendon Avulsion) lesion in a rotator cuff of a shoulder can be particularly difficult to repair. The rotator cuff comprises a group of muscles which surround the shoulder and tendons which attach those muscles to the humeral head. The tendons have a footprint where they attach to the humeral head and, in a PASTA lesion, a portion of the articular side of the rotator cuff tendon's footprint becomes detached from the humeral head. Such lesions are most commonly found on the supraspinatus tendon.
One option for treatment is completion of the partial tear and then completion of a repair using standard techniques for a full thickness tear. Preservation of the existing, healthy tissue attachment is thus lost and the entire tendon must be reattached. Another option includes screwing a threaded suture anchor through the tendon and into the humeral head, passing suture through the tendon and tying down the tendon to effect reattachment. This causes further trauma to the tendon.
There has been a long-felt need to provide a surgeon with access through soft tissue without excessively damaging the soft tissue. A number of early access devices including radially expandable dilators are disclosed by Dubrul et al. in U.S. Pat. No. 5,431,676. An appliance for forming an opening through skin is described by Jackson et al. in U.S. Pat. No. 4,716,901.
A more recent cannula device is disclosed by Putz in U.S. Patent Publication No. 2003/0073934. Two cannulas having side gaps are aligned without the side gaps juxtaposed to define a passage for a probe. The cannulas are then rotated relative to each other to facilitate separation from the probe.
It is therefore desirable to have an improved cannula system to minimize trauma to soft tissue while accessing bone.